Home Ventilator Failure
Objective: When a home ventilator is failing, give oxygen through the tracheostomy. Tell a circuit leak from a blockage. Do not change settings you were not trained to change.
Why this matters
A patient on a home ventilator can lose ventilation from a pulled circuit, a dead battery, water in the tubing, or a tracheostomy that is plugged. The machine alarm is a clue. Chest rise and the waveform decide whether the patient is being ventilated.
You do not have to be a ventilator technician to keep this patient alive. You do have to put oxygen into the trachea while you find the simple failure.
- If the patient is in distress, bag the tracheostomy with oxygen and the adapter you were trained to use.
- A low-pressure alarm usually means a leak or a disconnect. A high-pressure alarm with poor chest rise usually means obstruction: a mucus plug, water in the tube, the patient biting the tube, or a tube that has moved.
- Do not change modes, tidal volume, or alarms you were not trained to change. Protocol and the patient’s ventilator clinician own the settings.
- I am bagging the tracheostomy until the chest rises.
- This alarm is a leak, or this alarm is a blockage. I am checking the circuit and the tube.
- I am not changing the ventilator settings from this call.
Clinical sequence
- Look at the patient before you study the screen. Work of breathing, color, and chest rise come first.
- If ventilation is failing, disconnect the ventilator and bag the tracheostomy with oxygen. Suction if the tube may be plugged. Follow the tracheostomy steps if the tube itself is the problem.
- Trace the circuit from the patient to the machine. Reconnect what pulled apart. Empty water from the tubing. Check the power and the oxygen source.
- Put a waveform on the airway once you are ventilating. A flat line means you are not ventilating the lungs, even if the ventilator says it is delivering a breath.
- If the ventilator can be restarted safely on the patient’s usual settings, do that only if you were trained and the patient tolerates it. Otherwise keep bagging and move.
Teaching points
- DOPE still applies. Displacement, obstruction, pneumothorax, and equipment failure explain most sudden deteriorations. On a home ventilator, also check power and a disconnected circuit.
- Caregivers know the usual alarm. Ask what changed. A new high-pressure alarm after a turn in bed is different from a battery that was already failing.
- Speaking valves and caps can block exhalation if they are on the wrong patient or the cuff is up. If you do not know the device, take the extra piece off and oxygenate the stoma.
Common errors
- Silencing the alarm while the chest is not rising.
- Bagging the mouth and nose of a patient whose only airway is the tracheostomy, and ignoring the stoma.
- Changing the mode because the numbers look unfamiliar.
Practice
One-minute check
The low-pressure alarm is sounding and the tubing is on the floor. Say what you connect, what you bag, and what you will not reprogram.
Sources & Further Study
Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.
- NASEMSO National Model EMS Clinical Guidelines (2022) — tracheostomy and ventilator patients; local protocol owns device changes
- DOPE-S lesson — displacement, obstruction, pneumothorax, equipment, and seal
- Waveform capnography — a flat waveform means you are not ventilating the lungs
Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.
Check Your Understanding
Questions drawn only from this lesson. After you check, the key is highlighted. Education practice — not a certification exam.